Is Anesthesia Unsafe?

Many parents are naturally concerned about the amount of risk they are assuming when choosing to have their child put to sleep for dental work. Parents often think that general anesthesia is an excessive treatment solution for a simple problem like cavities.

The public is generally apprehensive about the very idea of being put to sleep for a variety of reasons. The anesthetic process is poorly understood, few people understand how it works.

There are a couple reasons why anesthesia is so misunderstood:

• Hollywood glamorizes the idea that people experience awareness while under anesthesia.
• The media publicizes stories of poor anesthesia outcomes and they don’t do a very good job of reminding the public of all the millions of positive outcomes that occur each year.

The reality is modern medicine wouldn’t be what it is today without anesthesia. Surgeries before the invention of anesthesia were crude, painful and dangerous. But anesthesia changed all that.

In this post, I’d like to discuss some of the commonly encountered risks of anesthesia and help to offer some perspective to the actual risk of encountering the more dangerous complications of anesthesia.

The Risks of Anesthesia

When people are nervous about anesthesia, they are often afraid that they “won’t wake up”.  If you dig deeper and look at the root of the concern, the underlying fear is usually a combination of a fear of losing control and a fear of death. To be sure, these are scary things, but the good news is we have less to fear than we think we do.

How often in life do we participate in activities where we actually have much less control than we think we do? I would advocate that in this day and age, we have very little control over most of the activities that we do participate in.

Every time we go to a public venue, we are at risk of being in the wrong place at the wrong time. In 2015, nearly 11 people per 100,000 died in a motor vehicle accident. This is equivalent to a 1 in 10,000 chance of dying in a fatal car crash. Yet, more people are afraid of flying on commercial airliners where the odds of dying in a fatal plane crash are 1 in 29.4 million. The human mind plays tricks on itself. We are more afraid of flying than driving simply because we aren’t in control.  

In fact, anesthesia and flight have a lot of similarities. Both have an operator who is responsible for the safety of others (the pilot for her passengers, the anesthesiologist for the patient.) Both mitigate the assumed risks by reviewing checklists to make sure their equipment is in working order and by paying careful attention to the information on their instruments and monitors. Both are highly trained and have extensively practiced dangerous scenarios so that they are prepared.

The anesthesia provider’s sole job is to act as a lifeguard, a guardian angel, or protector of the person who is being put to sleep. You may feel like you are surrendering control of the situation, but it is better to think of this as assigning control to a highly trained and skilled professional.

Anesthesia Risks By The Numbers

I’m not arguing that there aren’t risks when undergoing general anesthesia. Unfortunately, there are. But when considering these risks, it’s important to be mindful of the biases we have toward risks that we are unfamiliar with compared to risks that we encounter daily.

Unfortunately, there is a slight risk of dying from anesthesia. Quantifying that risk is difficult because there are a lot of contributing factors that must be controlled. The risk of death solely attributable to anesthesia is approximately 1 in 185,000 according to anesthesia textbooks. However, looking at a large study that reviewed nearly 2.9 million people that had general anesthesia, the death rate was around 33 per 100,000 people, or equivalent to 3.3 in 10,000.

Since this was a broad study that included major surgeries, patients at the extremes of the age spectrum (the very young and the elderly), and very sick patients, this number actually gives us some sense of relief. The ratio would be much lower when controlling for healthier patients and minor surgeries.  Considering that the perioperative rate of death in the general population is roughly equivalent to the incidence of fatalities due to car crashes in the general population, we can take some solace with regards to our case selection.

How To Reduce The Risks of Anesthesia

There are several strategies that we employ to help reduce the risk from anesthesia in our circumstance. Fortunately, the surgical risk is already very low. By their very nature, dental procedures are considered minimal or low risk due to the fact that they are minimally invasive. We don’t need to make large incisions for surgical access, there is minimal blood loss, and the procedures are not extensively long.

Case Selection

With general anesthesia in an outpatient setting, the primary factor in controlling for risk is careful case selection. This means that before we ever put your child to sleep, we are thoroughly reviewing his or her medical history. We have to make sure that our patients are generally in good health, and that any medical conditions are stable and well-controlled.

Patients with uncontrolled medical conditions or extensive health problems are better served in a hospital where they can either be admitted overnight for observation and have a larger team to tend to their needs.

We take case selection very seriously because it is an incredibly important aspect when it comes to anesthesia. If your child needs anesthesia we spend an entire appointment to review your child’s health history and determine the course of action with you and your child.

Anesthesia Plan

The development of an anesthesia plan goes a long way to ensuring that a safe anesthetic course will be delivered. Imagine you plan to build a house. Could you do it without first knowing what you want in a home, then selecting the house design and following the corresponding blueprint? No way, you’d end up with a home that wouldn’t be functional or safe to enter.

With anesthesia, we have to know what expectations you have and what your child’s health is before we can make an anesthesia plan. In this anesthesia plan, the anesthesia provider anticipates where they might encounter complications or difficulties and prepares strategies and methods to prevent or respond to them.

Careful Monitoring & Vigilance

In addition to case selection, another way that we help to reduce the risk your child is exposed to is through careful monitoring and vigilance. Just like in the comparison to pilots above, anesthesia providers utilize sophisticated monitors and instruments. While pilots use their equipment to ensure passengers have a safe flight, anesthesia providers use these monitors to make sure their patients’ vital signs stay within a normal range and to correct any deviations from normal immediately.

Final Thoughts

It’s worth repeating, we are all more comfortable with risks that we experience and encounter regularly, while risk that is foreign, or only occasionally encountered, makes us more squeamish. Just like the pilot who flies hundreds of thousands of miles a year doesn’t get anxious while flying, I tend to not get worried regarding anesthesia. However, I do still empathize with the anxiety and concern that you may have about anesthesia. It can be scary.

Unfortunately, there is no “secret sauce” or magic wand that we can wave to eliminate the risk from anesthesia. The good news is there are a number of steps that we always take that go a long way to reducing the risk. I want to assure you that at CDC, we never prescribe treatment that is unnecessary for your child. If we are recommending general anesthesia for your child, we have carefully weighed the risks and benefits and truly feel that this is the best option for treating your child’s dental needs.

The primary role of the anesthesia provider is to ensure a safe experience and outcome for you and your child. We take this role very seriously because we understand that it is an important responsibility. We believe your child is precious, and our primary aim is to make your appointment a safe and positive experience.

Questions? If you have questions about anesthesia or other dental concerns, please don’t hesitate to ask. You can call Children’s Dentistry of Charlottesville at (434) 817-1817, contact us online, or leave a comment below.